Board Information Form

Board Information Form

Organization Name:

Date (M/d/yyyy):

Current number of board members: / Number of years that constitute a board member’s term as stated in your bylaws:
Minimum number required by your bylaws: / Number of consecutive terms a board member may serve as stated in your bylaws:
Maximum number allowed by your bylaws: / Number of consecutive years that the board chair can serve as chair as stated in your bylaws:
Number of active board committees: / Number of years the board chair has served as chair:
Age breakdown of board members: Under 20: 20-39: 40-59: Over 60:
List characteristics important to note about the organization’s board members that are not defined by the characteristics on this form. This may include characteristics such as disability, sexual orientation, faith tradition, individuals who speak different languages or those with current or past experience with the issue(s) the organization addresses. (500 characters)
Provide any important information regarding the board, its members and its structure not captured by this form. (500 characters)
Name / Employer / Committee Membership or Leadership role (on your board) / Skills & Talents / Total Years on Board to date / Years Left in Term / Race/
Ethnicity / Gender
(Choose)African American or BlackAmerican Indian or Alaska NativeAsianHispanic or LatinoWhiteRace/Ethnicity not listed in this category
(Choose)African American or BlackAmerican Indian or Alaska NativeAsianHispanic or LatinoWhiteRace/Ethnicity not listed in this category
(Choose)African American or BlackAmerican Indian or Alaska NativeAsianHispanic or LatinoWhiteRace/Ethnicity not listed in this category
(Choose)African American or BlackAmerican Indian or Alaska NativeAsianHispanic or LatinoWhiteRace/Ethnicity not listed in this category
(Choose)African American or BlackAmerican Indian or Alaska NativeAsianHispanic or LatinoWhiteRace/Ethnicity not listed in this category
(Choose)African American or BlackAmerican Indian or Alaska NativeAsianHispanic or LatinoWhiteRace/Ethnicity not listed in this category
(Choose)African American or BlackAmerican Indian or Alaska NativeAsianHispanic or LatinoWhiteRace/Ethnicity not listed in this category
(Choose)African American or BlackAmerican Indian or Alaska NativeAsianHispanic or LatinoWhiteRace/Ethnicity not listed in this category
(Choose)African American or BlackAmerican Indian or Alaska NativeAsianHispanic or LatinoWhiteRace/Ethnicity not listed in this category
(Choose)African American or BlackAmerican Indian or Alaska NativeAsianHispanic or LatinoWhiteRace/Ethnicity not listed in this category
(Choose)African American or BlackAmerican Indian or Alaska NativeAsianHispanic or LatinoWhiteRace/Ethnicity not listed in this category
(Choose)African American or BlackAmerican Indian or Alaska NativeAsianHispanic or LatinoWhiteRace/Ethnicity not listed in this category
(Choose)African American or BlackAmerican Indian or Alaska NativeAsianHispanic or LatinoWhiteRace/Ethnicity not listed in this category
(Choose)African American or BlackAmerican Indian or Alaska NativeAsianHispanic or LatinoWhiteRace/Ethnicity not listed in this category
(Choose)African American or BlackAmerican Indian or Alaska NativeAsianHispanic or LatinoWhiteRace/Ethnicity not listed in this category
(Choose)African American or BlackAmerican Indian or Alaska NativeAsianHispanic or LatinoWhiteRace/Ethnicity not listed in this category
(Choose)African American or BlackAmerican Indian or Alaska NativeAsianHispanic or LatinoWhiteRace/Ethnicity not listed in this category
(Choose)African American or BlackAmerican Indian or Alaska NativeAsianHispanic or LatinoWhiteRace/Ethnicity not listed in this category
(Choose)African American or BlackAmerican Indian or Alaska NativeAsianHispanic or LatinoWhiteRace/Ethnicity not listed in this category
(Choose)African American or BlackAmerican Indian or Alaska NativeAsianHispanic or LatinoWhiteRace/Ethnicity not listed in this category
(Choose)African American or BlackAmerican Indian or Alaska NativeAsianHispanic or LatinoWhiteRace/Ethnicity not listed in this category
(Choose)African American or BlackAmerican Indian or Alaska NativeAsianHispanic or LatinoWhiteRace/Ethnicity not listed in this category
(Choose)African American or BlackAmerican Indian or Alaska NativeAsianHispanic or LatinoWhiteRace/Ethnicity not listed in this category
(Choose)African American or BlackAmerican Indian or Alaska NativeAsianHispanic or LatinoWhiteRace/Ethnicity not listed in this category
(Choose)African American or BlackAmerican Indian or Alaska NativeAsianHispanic or LatinoWhiteRace/Ethnicity not listed in this category

*If your organization has more than 25 board members (number of slots on this page), please provide the same information requested on this form on those additional board members in a separate document.

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